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Strabismus surgery in 4 year old child (Issues (Intraop (Occulo-cardiac…
Strabismus surgery in 4 year old child
Issues
Preoperative
Hx and exam
Causes
FHx
Associated disorder (craniofacial - mucopolysaccharis...)
Intraop
Use of topical mydriatic agents - can cause HTN
Occulo-cardiac reflex
Bradycardia in response to extraocular muscle traction
Reverts almost immediately after the stimulus is removed
Consider prophylaxis with atropine 20mcg/kg or glycopyrolate 10mcg/kg at induction
Airway mgmt - secure airway essential because face inaccessible (ETT or LMA)
Provision adequate surgical conditions - may require completely immobile eye (consider paralysis)
MH risk - increased in patients with Strabismus (avoid Sux)
Postop
Analgesia (Paracetamol, NSAID, intraop topical anaes, Fent 1mcg/kg)
PONV - prophylaxis with dexa and ondans
Emergence delerium
Prevention from discharge
Patient
Vital signs must be stable for at least 1 hour and adequate recovery from anaesthetic
N+V must be minimal
Analgesia must be adequate
ASA I or II
Social
Parent/responsible adult to take patient home in a suitable vehicle, within 1 hour of medical attention
Plan with written instructions on (E+D, analgesia, resume activities, contact number for emergencies)
Procedure
Postop complication risk minimal